Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The folds of skin that cover your genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris.

The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active, causing a need for more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and it may take longer to experience orgasm.

Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.

Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also may contribute.

Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.

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